Friday, July 11, 2003

This presentation is part of : Self Care in Chronic Illness

The Role of Self-Efficacy in Mediating the Health Status of the Chronically Ill

Kathleen Farrell, DNSc, Lecturer, Nursing, Murray State University, Murray, KY, USA, Mona N. Wicks, RN, PhD, Associate Professor and Director, PhD Nursing Program, College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, USA, Judy Carbage Martin, PhD, RN, CS, Associate Professor, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA, and Nancy D. French, MA, NHA, Director Gerontology, Gerontology, Lourdes, Paducah, KY, USA.
Learning Objective #1: Recognize the need to tailor an effective community-based lay led health intervention, the Chronic Disease Self-Management Program, to increase its cultural acceptability to underserved populations
Learning Objective #2: Recognize the concept of chronic illness self-management as a new paradigm of patient partnership with health care providers and incorporate this role into current clinical practice

Objective: This study examined if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-management behavior, health status, health care utilization, and clinical outcomes in an underserved rural population.

Design: Quasi-experimental pre-test, post-test design was used.

Sample, Setting: The sample, recruited from two rural clinics in a south central state, consisted of 48 middle and older adults (59.70+11.22 years) and was 79% Caucasian (n=38) and 20.8% (n=10) African American.

Concept: The study framework was based on Bandura’s self-efficacy theory.

Intervention: A chronically ill, master trainer and trained lay-leader directed the interactive CDSMP. CDSMP content included strategies to develop a personal exercise program, cognitive symptom management, problem solving, and communication skills.

Variables: Self-efficacy, self-management behavior, health status, health care utilization, blood pressure, low-density lipoprotein, glycosated hemoglobin, and body mass index were evaluated before and after the intervention.

Method: Program-specific paper and pencil instruments were completed during the first class and immediately after completion of the 6-week program.

Findings: Significant improvements (p< .10) in self-efficacy, self-efficacy health, health behaviors, perceived health status, and diastolic blood pressures occurred. Cognitive symptom management, health distress, and energy/fatigue significantly improved. There were no significant improvements in health care utilization or most clinical outcomes. Clinically significant reductions in fatigue, shortness of breath, and glycosated hemoglobin occurred, but these results were not statistically significant.

Conclusions: The CDSMP was efficacious in the study sample, improving self-efficacy, self-efficacy health, cognitive symptom management, and perceived health status. Longer follow up may be needed to detect improvements in clinical outcomes and health care utilization as underserved rural populations are disproportionately affected by chronic disease and its complications.

Implications: Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can significantly improve health outcomes in rural, underserved populations.

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Sigma Theta Tau International
10-12 July 2003